Provider Demographics
NPI:1144748534
Name:BALLESTEROS, KAITLYN (DPT)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:
Last Name:BALLESTEROS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8910 PURDUE RD STE 700
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-6136
Mailing Address - Country:US
Mailing Address - Phone:317-884-3383
Mailing Address - Fax:410-648-4878
Practice Address - Street 1:3280 URBANA PIKE STE 202
Practice Address - Street 2:
Practice Address - City:IJAMSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21754-9406
Practice Address - Country:US
Practice Address - Phone:301-874-2226
Practice Address - Fax:301-874-5955
Is Sole Proprietor?:No
Enumeration Date:2017-09-06
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD27045225100000X
DCPT872161225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist